Defining Subluxation: A Balancing Act

The Rubicon Group released its definition of subluxation in May 2017 resulting in a growing awareness and adoption of the definition in chiropractic circles. If you are not familiar with the specifics of the definition and the associated positioning statement accompanying it, these may be accessed at www.TheRubiconGroup.org/policies. The bibliography supporting the definition and the positioning statement are also available at the same site.

The Rubicon Group has been pleased to receive feedback and commentary on its subluxation definition project. This input will be carefully reviewed and combined with any additional literature published by May 1, 2018 for the 2018 annual review of the definition and it supportive documents. If you wish to offer your thoughts and evidence on how this definition or the supporting information can be improved we encourage you to complete the feedback page that can be found at www.TheRubiconGroup.org/policies/feedback As you may surmise from the phrase “2018 annual review,” TRG’s definition of subluxation is meant to grow and develop – and change – as we learn more from ongoing subluxation-centered research taking place around the globe.

Feedback thus far has fallen into three main categories; these can be grouped as coming from three distinct camps:

those expressing philosophic issues,

those reflecting a lack of understanding of the science reflected in the definition, and

those that reject the concept of subluxation as an entity.

The Rubicon Group sought to develop an evidence-based, testable definition that is reflective of the current state of the neuroscience associated with the concept of subluxation. The Rubicon Group did not attempt to develop a definition that would embrace every theory that has ever been conceived relative to subluxation as a concept. We are open to revisions of the definition released by The Rubicon Group based on the evidence that can be presented in support of such changes. The Rubicon Group has developed and presented “a” definition of subluxation, and we fully recognize that others may have expanded or differing definitions that extend beyond The Rubicon Group’s parameters of evidence-based, testable and consistent with contemporary neuroscience.

The concept of a subluxation being a “central segmental control problem” was not completely appreciated by some of our colleagues who interpreted this to mean that there was only a local motor control element associated with this definition. This is as far from the concept intended to be articulated as one could get! The discussion accompanying the definition, as well as the illustration accompanying the definition (see Figure 1 below), clearly indicated that at times the spinal component was at cause, and at other times, was an effect reflecting the varying circumstances present.

Figure 1: As indicated by the cycle of reciprocity in the above illustration, the concept of a subluxation being a “central segmental control problem” means that at times the spinal component is at cause, and at other times, is an effect.

The definition considered three elements—each of which could be a cause, or an effect. These included:

compromised movement patterns,

compromised adaptability, and

compromised neurophysiology.

To assist with a better understanding of the core statement of the definition, a follow-up graphic (Figure 2) has been designed to better explain each phrase of the definition.

Figure 2: The above illustration provides more context and depth, with each element of TRG’s definition of subluxation accompanied by color-matched commentary.

The evidence-based definition of subluxation advanced by The Rubicon Group has already begun to be reflected in presentations and publications around the world. It is not surprising that the conferences of The Rubicon Group have included a discussion of this definition, and it is heartening that similar conversations have been a part of scientific conferences and professional gatherings from Sydney to San Francisco!

In addition, the September 9, 2017, issue of Dynamic Chiropractic presented a front-page article on the development and release of the definition of subluxation by The Rubicon Group that has been met with considerable interest and acknowledgment from the profession.

The approach of The Rubicon Group to the definition of subluxation is important to the practicing chiropractor in many day-to-day settings, for example:

Every chiropractor is free to have whatever conversations they feel are appropriate about their care with their patients. This definition offers the practicing chiropractor a definition from which elements can be drawn and put into conversation with patients to help them understand the central nervous system aspects of a subluxation and the ramifications of this condition

One of the main goals of The Rubicon Group, in the definitional effort, is to provide the chiropractor with a biologically plausible, neuroscience supported, understanding of the condition we have referred to clinically as a subluxation. We also seek to have the understanding of the chiropractor move away from the nerve compression model of subluxation articulated many years ago and to move toward a model consistent with a contemporary understanding of the neuroscience associated with our care and the condition we refer to as a subluxation

If you accept third-party payment in your office, you can use the definition of The Rubicon Group as an evidence-based statement in support of your care and as an element of your explanation of the ramifications of subluxation

If you are involved in med-legal environments you now have a definition of subluxation that can be presented in deposition, in a hearing, or in open court for which there is supportive evidence for every component phrase of the definition, and resultantly the overall statement itself

If you are involved in chiropractic research, there is now a definition that is evidence-based that can be used to characterize the work you are doing using subluxation language with less concern for it being rejected as an unqualified concept

The Rubicon Group is excited to put forward this work in support of the chiropractor who wishes to embrace the concept of the subluxation as a clinical important entity that is uniquely addressed by the chiropractic community.